Use of the emergency department by refugees under the Interim Federal Health Program: A health records review.

INTRODUCTION:In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits. METHODS:We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011-2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals. RESULTS:There were a total of 612 IFH claims made in the ED from 2011-2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18-8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14-2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45-5.62; p<0.05). CONCLUSION:A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients

Demographics and frequency of ED use.

<p>Demographics and frequency of ED use.</p

Acuity of presentation and severity of diagnosis.

<p>Acuity of presentation and severity of diagnosis.</p

IFH claims status.

<p>IFH claims status.</p

Multivariate analysis for MD billings claims–rejected.

<p>Multivariate analysis for MD billings claims–rejected.</p

FB-BAL results from the 15 patients in whom positive cultures would have been missed if the right middle lobe had been sampled alone.

<p>RUL: right upper lobe, RML: right middle lobe, RLL: right lower lobe, LUL: left upper lobe, LLL: left lower lobe, CA: <i>Candida albicans,</i> GNB: Gram-negative bacillus, HI: <i>Haemophilus influenza,</i> HP: <i>Haemophilus parainfluenzae,</i> MC: <i>Moraxella catarrhalis,</i> SA, <i>Staphylococcal aureus</i>; SP, <i>Streptococcus pneumoniae</i>.</p><p>FB-BAL results from the 15 patients in whom positive cultures would have been missed if the right middle lobe had been sampled alone.</p